Association of Left Ventricular Global Longitudinal Strain With Asymptomatic Severe Aortic Stenosis

Vollema, E. Mara; Sugimoto, Tadafumi; Shen, Mylène; Tastet, Lionel; Ng, Arnold C.T.; Abou, Rachid; Marsan, Nina Ajmone; Mertens, Bart; Dulgheru, Raluca; Lancellotti, Patrizio; Clavel, Marie‐Annick; Pîbarot, Philippe; Généreux, Philippe; Leon, Martin B.; Delgado, Victoria; Bax, Jeroen J.

doi:10.1001/jamacardio.2018.2288

Cited by 142 publications

(105 citation statements)

References 42 publications

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“…Therefore, 3-dimensional (3D) speckletracking echocardiography could provide a more precise representation of myocardial deformation [12]. New insights into LV remodeling and myocardial deformation could potentially improve our ability to identify patients with aortic stenosis who are at highest risk for adverse remodeling or early LV dysfunction [13][14][15][16][17][18]. However, few studies have comprehensively characterized myocardial deformation in patients with severe aortic stenosis by 3D speckle-tracking echocardiography [18,19].…”

Section: Introductionmentioning

confidence: 99%

Dissecting myocardial mechanics in patients with severe aortic stenosis: 2-dimensional vs 3-dimensional-speckle tracking echocardiography

Yeung

Salah

et al. 2020

BMC Cardiovasc Disord

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Background: Aortic stenosis (AS) causes left ventricular (LV) pressure overload, leading to adverse LV remodeling and dysfunction. Identifying early subclinical markers of LV dysfunction in patients with significant AS is critical as this could provide support for earlier intervention, which may result in improved long-term outcomes. We therefore examined the impact of severe AS and its consequent increase in LV afterload on myocardial deformation and rotational mechanics by 2-dimensional (2D) and 3-dimensional (3D) speckle-tracking echocardiography. Methods: We prospectively measured various strain parameters in 168 patients (42% female, mean age 72 ± 12 years) with severe AS and LV ejection fraction (EF) ≥50%, and compared them to normal values found in literature. 2D and 3D images were analyzed for global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), basal rotation, apical rotation, and peak systolic twist. We further assessed the degree of concordance between 2D and 3D strain, and examined their association with measures of LV preload and afterload. Results: Patients with severe AS exhibited significantly lower GLS and GRS but higher GCS, apical rotation, and twist by 2D and 3D echocardiography compared with published normal values (P = 0.003 for 3D twist, P < 0.001 for all others). Agreement between 2D-and 3D-GLS by concordance correlation coefficient was 0.49 (95% confidence interval: 0.39-0.57). GLS was correlated with valvulo-arterial impedance, a measure of LV afterload (r = 0.34, p < 0.001 and r = 0.23, p = 0.003, respectively). Conclusion: Patients with severe AS demonstrated lower-than-normal GLS and GRS but appear to compensate with higher-than-normal GCS, apical rotation, and twist in order to maintain a preserved LVEF. GLS showed a modest correlation with valvulo-arterial impedance.

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Section: Introductionmentioning

confidence: 99%

Dissecting myocardial mechanics in patients with severe aortic stenosis: 2-dimensional vs 3-dimensional-speckle tracking echocardiography

Yeung

Salah

et al. 2020

BMC Cardiovasc Disord

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“…5 Studies in patients with asymptomatic AS have demonstrated that subclinical LV dysfunction can be reliably identified by deformation imaging. [6][7][8][9][10] Resting global longitudinal strain (GLS) and basal longitudinal strain (BLS) are significant independent predictors of outcomes in patients with significant AS. Increased mechanical dispersion was shown to be a prognostic predictor in patients with severe AS with and without intervention.…”

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confidence: 99%

The Association Between Longitudinal Strain at Rest and Stress and Outcome in Asymptomatic Patients With Moderate and Severe Aortic Stenosis

Levy-Neuman

Meledin

Gandelman

et al. 2019

Journal of the American Society of Echocardiography

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Background: Calcific aortic stenosis (AS) is a progressive disease, and once moderate AS is present, the likelihood of symptom onset within 5 years is significant. The aim of this study was to determine the incremental value of global longitudinal strain (GLS) and basal longitudinal strain (BLS) at rest and during exercise on outcomes among asymptomatic patients' with moderate and severe AS. Methods: Seventy-five patients with isolated, asymptomatic AS and preserved left ventricular function were retrospectively enrolled and underwent symptom-limited exercise echocardiography. Clinical and echocardiographic data, including GLS and BLS at rest and during exercise, were assessed. Occurrence of ASrelated cardiovascular events was recorded. Results: The mean age was 71 6 10 years, and 63% were men. The mean aortic valve gradient was 30 6 11 mm Hg, and the mean aortic valve area was 0.98 6 0.21 cm 2. Resting GLS and BLS were À16.5 6 4% and À16.9 6 3.6%, respectively. Exercise stress test results were positive in 27 patients (36%). Mean exercise GLS was À17.8 6 3.5%, and mean exercise BLS was À17.9 6 4%. During mean follow-up of 34.5 6 3.5 months, cardiovascular events were observed in 45 patients. In multivariate analysis, aortic valve mean gradient (HR, 1.073; 95% CI, 1.032-1.115; P < .001) and peak exercise BLS (HR, 1.177; 95% CI, 1.07-1.295; P = .001) were associated with cardiac events during follow-up. Conclusions: Reduced exercise BLS is associated with future cardiovascular events in patients' with asymptomatic AS, independently of clinical factors and conventional echocardiographic parameters. Detection of postexercise myocardial dysfunction in patients with asymptomatic AS with preserved left ventricular function can aid in risk assessment of these patients.

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“…Unfortunately, the occurrence of low LVEF (<50%) in the absence of symptoms in severe AS is very rare (0.4%) (36). Irrespective of symptomatic status, patients with severe AS may have a subclinical left ventricular dysfunction determined by a decreased LV-GLS value (37). Recent studies suggested that even patients with LVEF value between 50% and 59% had unfavorable postoperative outcome compared to patients with LVEF value more than 60% (36).…”

Section: B) Lv-gls In Aortic Stenosismentioning

confidence: 99%

Looking beyond ejection fraction: what we have in echocardiography

Baysan¹,

Akyıldız²

2019

HVT

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Left ventricular ejection fraction (LVEF) is the most frequently used echocardiographic parameter. LVEF based heart failure classification, timely intervention in a patient with valvular disease (e.g. aortic stenosis, mitral regurgitation), deterioration of myocardial function in a patient treated with chemotherapy; all need a simple LVEF value for decision-making process. An echocardiographic examination also contains several parameters with invaluable importance. Measurement and evaluation of these parameters should be made in every patient suspected of having myocardial disease.

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Association of Left Ventricular Global Longitudinal Strain With Asymptomatic Severe Aortic Stenosis

Cited by 142 publications

References 42 publications

Dissecting myocardial mechanics in patients with severe aortic stenosis: 2-dimensional vs 3-dimensional-speckle tracking echocardiography

Dissecting myocardial mechanics in patients with severe aortic stenosis: 2-dimensional vs 3-dimensional-speckle tracking echocardiography

The Association Between Longitudinal Strain at Rest and Stress and Outcome in Asymptomatic Patients With Moderate and Severe Aortic Stenosis

Looking beyond ejection fraction: what we have in echocardiography

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